Velega officially resigns LBJ board; blasts Saleapaga

Hospital Board Chairman Mase Akapo and Governor’s Executive Assistant Iulogologo Joseph Pereira told Samoa News last week that they would not honor a verbal resignation rendered by Velega Savali during a meeting held with the Governor two weeks ago, but rather the resignation must be in the form of an official letter.

On Wednesday, this week, the former hospital board member, Velega Savali sent his resignation letter to the Hospital Board, reaffirming what he had voiced in the last meeting he attended.

In his letter to Governor Lolo Matalasi Moliga, the former board member thanked Lolo for the opportunity to serve on the hospital board, however he noted that after being on the hospital board for a few months he realized “what is going on at the hospital is something that is too deeply rooted, [and] that any dissenting voice will be meet with strong opposition.”

Velega said he feels strongly that his staying on the board would not serve any useful purpose for the government or the people of American Samoa and apologized for any inconvenience his resignation has caused. He further gave his apology to those who had supported him or urged him to stay on the board.

He noted that he hopes people will understand the reason for his stepping down from the board. Velega explained, “My one vote will not make a difference; I am truly sorry.” He also extended his sincere appreciation to the Senators for their vote of confidence, which enabled him to serve on the hospital board.

In an exclusive interview with Velega, he told Samoa News that one of the reasons he resigned was due to the fact the hospital had rehired Dr. Iotamo Saleapaga, as Medical Director.

Velega said the previous Hospital Board and the former hospital CEO Mike Gerstenberger had not renewed Dr. Saleapaga’s contract for specific reasons.

Samoa News has received a copy of correspondence between Dr. Saleapaga and then CEO Gerstenberger regarding his request for a contract renewal, which cites issues under the headings of Clinical, Citizenship and Contact concerns. We also obtained a copy of a “Memo for the Record”, recorded by Gerstenberger, concerning the meeting he held to discuss the contract renewal and the hospital’s concerns, and to allow Dr. Saleapaga to respond to issues he raised. The documents were leaked to Samoa News from a former hospital board member of the Togiola Administration — and Velega was told we have them in our possession.

Referring to the leaked documents, Velega noted that back in September 2012, Gerstenberger said he had received Dr. Saleapaga’s request for renewal of his contract, however according to the ASMCA Human Resources Personnel Policy and Administration Manual, renewal is a prerogative of management based on need and performance.

“Gerstenberger in his letter stated that there were a number of serious questions relating to Dr. Saleapaga, which raised serious questions about his performance,” Velega pointed out. “This caused then CEO Gerstenberger to question his (Saleapaga’s) request for renewal; and the CEO further noted there were clinical, citizenship and contract concerns which required investigation and if substantiated, remediation.”

Velega said that among the clinical concerns raised by then CEO Gerstenberger was the absence of a CPRS (Computerized Patient Record System) record of required daily visits and progress notes on many of his inpatients, including critically ill patents in the ICU.

The letter also raised questions about the doctor’s dosing and monitoring of certain antibiotics and certain xanthenes, and also his dosing in the treatment of asthmatic patients, along with his monitoring of diabetic patients.

According to the letter, the former LBJ CEO stated that during “the second Quarter of this Fiscal Year” (which would be 2012, the letter is dated Sept. 4, 2012), Dr. Saleapaga managed the smallest number of inpatients—13— while other physicians saw patients ranging from 28- 69 in number, and during that same period “your mortality rate was the highest of any practitioner in the service at 23%. The Mean Mortality Rate was 12%.

“Your average length of stay for this period was also the highest in the service at almost ten days. The Mean was slightly over 6 days,” wrote Gerstenberger.

Velega also pointed out that in this same letter, Gerstenberger noted that “physicians and nurses at the time reported in the ER and the ICU that Saleapaga, when on-call was “frequently argumentative, unhelpful and generally non-responsive to patient issues.”

The former CEO, in his letter, also noted Dr. Saleapaga’s routine of seeing patients in the Clinic prior to the clinic’s opening time, violated hospital policy, because policy dictates the clinic, when opened, must have enough staff present during the examination of patients, and patients are put at risk if there are any emergencies which occur during the time when a clinic is unstaffed. Further it also violated “the hospital policy on chaperones which requires the presence of a staff person be present during the examination of a patient of the opposite sex.”

The high number of outpatients the doctor did see in the Clinic, was also in question — due to it being twice the amount of patients seen by other practitioners — and “the adequacy of the care” provided was noted.

Under Citizenship concerns, the letter to Dr. Saleapaga notes in four points that the doctor is not a team worker. In particular, he wrote the doctor does “not assume call obligations in an equitable manner. It is reported by numerous locums providers that you have declined to take your assigned call and “dumped” additional call obligations on them or other providers in the Service.”

Under Contract concerns, Gerstenberger highlights that Dr. Saleapaga was “cautioned by the Hospital Counsel in October of 2011 regarding outside employment which is not allowed” under his current contract.

In the “Memo for Record” dated September 5, 2012 leaked to Samoa News, it is noted it was “Recorded by Gerstenberger”, and it outlines what happened during the meeting Dr. Saleapaga was requested to attend “to discuss his request for renewal of his contract.”

The former LBJ CEO wrote that present at the meeting was Dr. Saleapaga, Dr. Anesi (CMO), Chairman of the Board, Moananu Va, Secretary of the Board, Lelei Peau and himself.

The meeting according to the memo was to discuss Dr. Saleapaga’s request for renewal of his contract and to discuss a number of issues related to the doctor’s performance; and before any discussion could ensue, “Dr. Saleapaga dismissed the legitimacy of the meeting stating that it was all ‘hearsay’ and ‘bullshit’.”

The memo further noted the doctor “stated emphatically that the CEO ‘isn’t a physician and doesn’t know what he’s talking about.’ Mr. Gerstenberger responded stating that the quality of care provided in the Hospital was ultimately the responsibility of the Board and that the renewal of the contract provided an opportunity to review that care.”

According to the Memo for Record, throughout the meeting, Dr. Saleapaga is noted as being cautioned by Moananu and Peau regarding his comments in the Samoan language, as well as for his use of profanities.

The doctor also insisted that “he should have received the concerns in writing in advance and has had no time to respond to them.” Gerstenberger reiterated that the meeting was to discuss the concerns raised and to provide Dr. Saleapaga an opportunity to address them.

However, the doctor “repeated his position using profanities,” the memo states, and continued: “He stated he had been caring for people on island for 40 years and was not going to be told what to do by those who are not physicians. He stated he was unwilling to discuss any of the issues at the meeting.”

In the end, the meeting which began at 2:45p.m. and ended at 3:10p.m., concluded with those present agreeing to allow Dr. Saleapaga to review the letter (Sept. 04, 2012) he had received and respond to the CEO (Gerstenberger). The clinical issues discussed in the letter were to be reviewed with Dr. Anesi.

Numerous calls from Samoa News to Dr Saleapaga at his office and clinic were not immediately returned.